Regenerative Endodontic Procedure in an Immature Permanent Incisor with Internal Root Resorption: a Case Report

Abstract

This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field.

Keywords: Mineral trioxide aggregate; Odontogenesis; Regenerative endodontics; Root resorption; Tooth intrusion.

Figure 1

a: The initial radiograph taken 5 days before first visit shows internal root resorption and an open apex, b: Sinus tract at teeth #9, c: radiograph with a gutta-percha cone through the sinus tract, d: working length with a #80 K-file, e: absence of sinus tract in the second appointment, f: The 24 month radiograph shows a complete healing of the periradicular lesion, inhibition of the root resorption process, and formation of the new periodontal ligament as well as tooth widening development, g: a favorable evolution of the treatment at 48 months with development of a hard tissue bridge and MTA removal, h: photography that shows discoloration of the tooth, i: whitening of the tooth after MTA removal, and restoration with resin composite and a buccal direct composite veneer.